HHS: Return Overpayments within 60 Days

February 29th, 2012

The U.S. Department of Health & Human Services (HHS) wants providers and suppliers who receive funds under Medicare to return overpayments within 60 days. Specifically, overpayments would have to be reported and returned by “60 days after the date on which the overpayment was identified; or any corresponding cost report is due, if applicable,” according to a notice of proposed rule-making (NPRM) in the Feb. 16 Federal Register.

This proposed rule would implement section 6402(d) of the Affordable Care Act, which “requires the Secretary establish a process for a provider or supplier to return an overpayment to the program, as well as establish a process for CMS and its contractors to receive and apply the overpayment.”

Examples of overpayments under this proposed definition are:

  • Medicare payments for noncovered services
  • Medicare payments in excess of the allowable amount for an identified covered service
  • Errors and nonreimbursable expenditures in cost reports
  • Duplicate payments
  • Receipt of Medicare payment when another payer had the primary responsibility for payment

Make a Comment

Comments in regards to the proposal must be received no later than 5 p.m. on April 16, 2012. When commenting, please refer to file code CMS-6037-P. You may submit comments through one of these four ways:

1. Electronically. Follow the “Submit a comment” instructions.

2. Regular mail. Send written comments to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-6037-P, P.O. Box 8013, Baltimore, MD 21244-8013.

3. Express or overnight mail. Send written comments to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-6037-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.

4. Hand or courier. If you prefer, you may deliver (by hand or courier) your written comments before the close of the comment period. See specific instructions and addresses for hand or courier delivery in the proposed rule.


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5 Responses to HHS: Return Overpayments within 60 Days

  1. Sangita Says:

    We have tried refunding overpayments. Even after notifying them and sending the check, they end up recouping the amount off of another payment. It’s a mess in our books and a pain to then get our money back.

  2. Tiffany Says:

    I have had the same problem with sending a check to Medicare, just to have them recoup it too. Or, they will just send the check back to you if they do not show a credit in their books. I think they should just recoup the credit when they send the corrected eob. I know, I know…”What are you thinking?!” Well, if you think about it…(1) Medicare ends up recouping the overpayment anyway and charging you interest if it’s over 45 days (2) you send a redetermination request to the overpayment department, but, before they can process the request, they again recoup the overpayment and interest charges (3) you send them a check and before it can be processed, they again recoup the overpayment and interest charges. If you need to send a redetermination request to get your payment back, then so be it. You were going to need to do that anyway, but they would have charged you interest when they recouped. So, if they just recouped the payment with the corrected eob, it would save both Medicare and billers paper and man power to process the corrected eob, recoupement, redetermination request and follow up.

  3. erica Says:

    If they are going to implement this…then, they MUST simplify the process….it is torture getting them to see the overpayment, or making sure you dot your i’s and cross your t’s….on the paperwork you have to fill out…we can easily identify an overpayment on our end…and we can clearly see when something needs to be refunded…it is getting them to do their part that is holding up all the $$ that needs to be recoup’d/refunded….and then they are going to charge us interest if it is not done in 60 days… not sure what the solution is here…but, I HATE credits and am happy to send the $$ back ASAP…but, it is NOT that simple!!! when it should be….

  4. Sue Says:

    Recoup is the most efficient and cost effective method…but they have to clean up the EOBs so the reason and charge being recouped is actually clear. Even Medicare cannot tell us what some of their recoup messages mean.

  5. AMA: Overpayment Rule May Force Record Hording | AAPC News Says:

    [...] Hording March 16th, 2012 The U.S. Department of Health & Human Services (HHS) plans to collect overpayments within 60 days of discovery to bolster an ongoing assault on fraud and abuse, but the move may require practices [...]

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